Could Trusting Your Doctor Impact Your Health in America? ========================================================= * Michael E Johansen * Christal M Clemens The *Annals of Family Medicine* encourages readers to develop a learning community to improve health care and health through enhanced primary care. Participate by conducting a journal club. We encourage diverse participants to think critically about important issues affecting primary care and act on those discussions.1 ## HOW IT WORKS In each issue, the *Annals* selects an article and provides discussion tips and questions. Post a summary of your conversation in our online discussion. (Open the article, click on the eLetters tab, and submit a comment.) Discussion questions and information are online at: [https://www.AnnFamMed.org/content/AJC](https://www.AnnFamMed.org/content/AJC). ## CURRENT SELECTION Bazargan M, Cobb S, Assari S. Discrimination and medical mistrust in a racially and ethnically diverse sample of California adults. *Ann Fam Med*. 2021;19(1):4-15. ### Discussion Tips A better understanding of how individuals of different racial and ethnic backgrounds experience and view the medical care system could impact the health of a population. A better causal model that accounts for these perceptions might allow for better design of care systems and a greater appreciation of these perceptions might affect how individual clinicians interact with patients. ### Discussion Questions * What question is asked by this study and why does it matter? * How does this study advance beyond previous research on this topic? * How strong is the study design for answering the question? * o. What are the benefits and weaknesses of the survey design and administration? * o. What are the potential biases created by the survey design? * o. What confounding variables are present within the study? * ▪ What is the difference between a moderator and a mediator? Which of these should be controlled for in a regression analysis? * ▪ What is endogeneity? What happens to a model if there is endogeneity built into a model? * o. What type of model did the author’s use? What are the assumptions of a multinomial logistic regression? What’s the difference between ordinal and multinomial logistic regressions? * To what degree can the findings be accounted for by: * o. How the main outcome variables were measured? * What findings do you notice in the bivariate analyses (Table 3)? How do these compare to the multivariable model? * o. Do you think reporting having a primary care physician is a cause and/or effect of medical mistrust? How might this impact our causal model? * o. What’s the difference between a point estimate and a confidence interval? * How comparable is the study sample to similar patients in your practice? What is your judgment about the transportability of the findings? * What contextual factors are important for interpreting the findings? * o. How would you gauge the potential benefits and harms of the study? * How might this study change your practice? Education? Research? * Who are the constituencies for the findings, and how they might be engaged in interpreting or using the findings? * What are the next steps in interpreting or applying the findings? * What researchable questions remain? * © 2021 Annals of Family Medicine, Inc. ## References 1. 1.Stange KC, Miller WL, McLellan LA, et al. *Annals* Journal Club: It’s time to get RADICAL. Ann Fam Med. 2006;4(3):196-197. [http://annfammed.org/cgi/content/full/4/3/196](http://annfammed.org/cgi/content/full/4/3/196). [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiNC8zLzE5NiI7czo0OiJhdG9tIjtzOjIzOiIvYW5uYWxzZm0vMTkvMS9paWkuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9)